Provider Demographics
NPI:1942979851
Name:FISHER, AMY VEAZEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:VEAZEY
Last Name:FISHER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:VEAZEY
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16590 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-2646
Mailing Address - Country:US
Mailing Address - Phone:618-521-4657
Mailing Address - Fax:
Practice Address - Street 1:3333 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5884
Practice Address - Country:US
Practice Address - Phone:618-998-7907
Practice Address - Fax:618-998-7908
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07.010830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist